Abstract

Background: To evaluate the efficacy of mifepristone in pre induction cervical ripening in term pregnancy. Materials and Methods: Prospective interventional randomised comparative study, done at Holy family hospital New Delhi. 100 patients were selected randomly with a bishop score less than 6. The study group included fifty patients who received 200 mg oral mifepristone (if applicable, repeat once after 24 hrs). The expectant group included 50 patients, whom we observed for 48hrs without interference. Comparison was done in terms of improvement in bishop score, need for further induction and augmentation of labour, induction to delivery interval and mode of delivery. Results: In the mifepristone group, there was a statistically significant difference in the number of PGE2 gel required with a p value of 0.0001. The study group demonstrated a significantly lower proportion of patients requiring further doses of PGE2 gel compared to the expectant group. The median PGE2 gel to delivery interval in the expectant group was 11.5hrs which was significantly higher compared to the study group, where the median interval was 8 hrs. In our study there was a statistically insignificant difference in the improvement in the bishop score with a p-value of 0.824, also in terms of complications and neonatal outcome. Conclusion: This study showed that oral mifepristone given for pre induction cervical ripening is an effective agent when given at least 24- 48 hrs prior in full term pregnancy.

References

1. Mackenzie IZ. Introduction of labor at the start of the new millennium Reproduct. 2006;131(6):989-98.
2. Tenore JL. Methods for cervical ripening and induction of labor. Am Fam physician. 2003;67(10):2123-8.
3. Hapangama Dharani, Neilson JP. mifepristone for induction of labor . A Cochrane database of systemic reviews.2009;3:CD002865.
4. R.S. Satoskar, S.D Bhandarkar, Nirmala N. Rege Pharmacology Pharmacotherapeutics, Popular Prakashan 25th edition Antifertility agents and Ovulation inducing drugs Ch-66– Pg 956.
5. Frydman R, Lelaidier C, Baton-saint-Mleux C, Fernandez H, Vial M, Bourget P et al. Labor induction in women at term with mifepristone: a double-blind controlled trial. Obstet Gynecol 1992; 80:972-5.
6. Baev OR, Rumyantseva VP, Tysyachnyu OV, Kozlova OA, Sukhikh GT. Outcomes of mifepristone usage for cervical ripening and induction of labor in full-term pregnancy. Randomized controlled trial. Eur J Obstet Gynecol Reprod Biol. 2017 Oct; 217:144-149. doi: 10.1016/j.ejogrb.2017.08.038. Epub 2017 Sep 1. PMID: 28898687.
7. Sujithra S, Onimi S, Godla UR. Efficacy ofMifepristone in Preinduction Cervical Ripening in Term Pregnancy.J South Asian Feder Obst Gynae 2022;14(2):184–188.
8. Li L,Gao W,Chen S, labor induction in women at term with mifepristone and misoprostol. Zhonghua Fu Chan Ke Za Zhi. 1996 Nov;31(11):681-4.
9. Wing DA, Fassett Michael J, Mishell Daniel R. Mifepristone for preinduction cervical ripening beyond 41 weeks' gestation: a randomized control trial. Obstet Gynecol. 2000; 96:543-8.
10. Yelikar K, Deshpande S, Deshpande R, Lone D. Safety and Efficacy of Oral Mifepristone in Pre-induction Cervical Ripening and Induction of Labour in Prolonged Pregnancy. J Obstet Gynaecol India. 2015 Jul;65(4):221-5.